Medicina
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Histoplasma capsulatum is an environmental fungus commonly found in the Ohio and Mississippi River valleys, Central and South America, and Asia. The most affected areas in Argentina are the Paraná and de La Plata river basins. ⋯ Most of them are asymptomatic, while those with compromised cellular immunity are at increased risk for the disseminated form. We present the case of a patient undergoing treatment with methotrexate for seronegative arthritis who developed the disseminated form of the disease, and who represented a diagnostic challenge due to the difficulty in identifying the etiologic agent.
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Migraine is a very prevalent disorder that is estimated to affect about 10-15% of adult subjects. According to the World Health Organization migraine is one of the first causes of disability. Traditional preventive treatments discovered by serendipity include Beta blockers, antinconvulsants drugs, calcium channel blockers, tricyclic antidepressants and onabotulinum A and offer about 50% efficacy after controlled placebo trials and real life use. ⋯ This family of drugs: erenumab, galcanezumab, fremanezumab, eptinezumab, finished Fase III, extensions trials and many of them are in the market approved since 2018. Since 2019 are available in Argentina. We will describe the rationale for the prescription of this family of new drugs for migraine.
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Takotsubo syndrome is a generally reversible cardiomyopathy often related to a stressor trigger, either physical or emotional. It is estimated that this entity represents between 1 and 6% of the cases of suspected acute coronary syndrome without ST segment elevation in women. Coexistence with coronary artery disease has been a matter of long controversy. ⋯ However, due to the strong suspicion of stress cardiomyopathy, a cardiac magnetic resonance imaging with gadolinium was performed, which showed an improvement in the ejection fraction prior to revascularization with the presence of myocardial edema and absence of late gadolinium enhancement. The aforementioned characteristics led to the diagnosis of Takotsubo syndrome. The final decision of revascularization was based on the fact that the patient's principal complaint was typical anginal symptoms.
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Acquired hemophilia A is an unusual bleeding disorder of autoimmune origin resulting in the formation of autoantibodies directed against coagulation factor VIII. These autoantibodies can act by partially or completely neutralizing the activation or function of the factor, or they can also accelerate its elimination from the circulation. ⋯ In nearly 50% of cases, an underlying disease that is presumed responsible to produce autoantibodies can be detected. We report a case with acquired hemophilia A, in a patient with Vater's ampulla adenocarcinoma.
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Hydatidosis - caused by the parasite Echinococcus granulosus - is a zoonosis endemic to the province of Santa Cruz, associated with areas of livestock production. Once infected, man may remain asymptomatic for a prolonged period but the disease has an important impact on public health owing to the complexity and costs of its treatment. This study aimed at assessing the prevalence of environmental E. granulosus infection in rural and peri-urban areas of the town of Los Antiguos, through the detection of antigens in scattered canine feces, and to identify risk factors for transmission. ⋯ In turn, about half of the surveyed population ignored the modes of transmission of the infection and the measures to prevent it. This work shows a high infection index in the area and establishes a baseline for future comparisons. It also reinforces the need to implement education, prevention, and control activities at the local level - according to national program guidelines - in order to reduce the prevalence of environmental contamination of the disease.